Having attended the National Council State Board of Nursing annual convention this month, I was once again reminded of the divisiveness of the nursing profession and the importance for us, at all levels of practice, to come together with a united voice.  I know that it seems an impossible task, but I am a true believer that impossible tasks are the ones we have chosen not to make a priority for solution.  As I sat in on meetings I heard another group advocate that a BSN should be the minimum requirement for "professional" nursing (RNs).  I heard another group say LPNs should not be allowed to expand their scope of practice.  A committee report to the council suggested how CNAs should be delegated to in nursing practice.  Finally, the worst of this divisiveness I saw was when one state announced they had just opened a new diploma school of nursing and the outbreak of emotional responses was quite unprofessional to say the best.  As I looked at all the happenings, it occurred to me that we risk yet another "turf battle" in the near future as advanced practice nurses expand in numbers.  Will the next battle we see be these APRNs fighting to keep RNs from expanding their roles unless they obtain advanced degrees?  Well if our history continues unchecked, I'd be willing to guarantee it will happen.

As noted above, at one of the breakout sessions, a relatively new association joined with the ANA and stated that the minimum education level for a registered nurse must be a BSN.  I spoke with that organization's president after the session ended, making a simple point.  When organizations make these blanket statements, without forwarding a plan that addresses the concerns of the majority of RNs who do not have a BSN, such agendas can only be damaging to the profession.  What is your plan for ADNs, diploma nurses, LPNs, and nursing assistants?  Are they just to be swept under the rug, or will they be given grants to continue their education?  More importantly, can any group attain "professional" status, recognition and pay without having a group or group that helps them deliver service to their clients.  All the "professions" have individuals, not as well-trained but capable and competent, who help deliver their professional service to their clients.  For example, attorneys depend on para-legals, business executives depend on executive assistants, and physicians depend on physician assistants and nurse practitioners, and the list goes on.

Some will tell you that it's important to have laundry lists of what certain levels of nurse can and cannot do within their "scope of practice".  In my opinion, this can do nothing but hurt us as a profession.  First of all, we do it more to protect our "turf" than to protect the public.  Little if any research backs the creation, validity, or necessarily of these laundry lists.  LPNs doing IV therapy!  Who would have ever thought.  Well, if nursing didn't progress, RNs would still not be taking blood pressures, let alone doing IV therapy.  We must realize that we are in a dynamic and rapidly growing industry.  As knowledge and capabilities expand, so too must the knowledge and capabilities of all practitioners of nursing, regardless of their educational level.  Don't buy in to any group that tells you a certain level of training is necessary to provide a skilled service to patients in any setting.  Nursing schools at all levels train and educate their graduates to meet minimum competency to begin practice.  It is with years of experience, ongoing education, and dedication that we become experts in any facet of our profession.

Yes, regulators must provide nurses with a "scope of practice", but these legal documents must be written to allow for our profession's ever-expanding roles.  Many states use broad statements that meet these criteria and these scopes of practice documents should be adopted by the NCBSN as model regulations for all states.  Let's not set ourselves up to fail just when the need for nurses will be its greatest since World War II.

Let me address briefly the who, what, where, when, why and how of all this.

Who should be involved in finding solutions to this problem?
All nurses, RNs, LPNs, and CNAs should be invited to become involved in addressing the issues and creating a direction for the nursing profession.  I'm sure most would agree that registered nurse should lead the way, but answers that are derived by exclusive groups rather than inclusive groups will only continue to divide our numbers and whittle down our ability to determine our own fate.

What do we need to do to effectively address these issues?
The answer, in my opinion is both obvious and simple.  A new council needs to be created, comprised of representatives from all the major nursing associations and groups.  It would have members at all levels of the nursing practice.  Its members would serve as "ambassadors" for their organization.  Collectively they should create recommendations and position papers that can be taken back to their respective organizations with strong recommendations for adoption.

Where do you go to help make such positive and effective change begin?
It is important for you to begin a dialogue with your professional association and insist that nursing's future be in the hands of front line nurses.  Talk with your colleagues and get a nursing running nursing.

When do we need to get started?
As you might well imagine, the present is the very best opportunity for nurses and nursing to achieve every dream any of has ever had for our profession.  The good news is we have a window of several years to get it all accomplished; however, we cannot wait for the impending nursing crisis to worsen to a point where lawmakers will take our professional destiny out of our hands and put it in the hands of the reactionary!

Why is this important?
Because regulation of nursing practice is first and foremost a legislative matter, it is important for nurses to end divisiveness and speak with one voice so that we can be an effective lobby.  Currently we have too many associations, representing too many sub-interests, often in total disagreement with one another.  The foundation for most of this are "turf battles" I addressed earlier.  In order to be effective in lobbying both legislatures and regulators, nursing must speak with a united voice.

How do you get involved and make it all happen?
First and foremost, you must get involved with at least one of the major nursing associations.  The broader the representation of the association the better and more likely that such initiatives can be advance within the group.  These initiatives must be inclusive, not exclusive and they must create a model of nursing practice that can be advanced on a national basis.  It must be an initiative endorsed and embraced by the majority of nurses at all levels of training and experience. 

I know you may be thinking that I believe in perfection (I would have used the word utopia, but there is no need for nurses in utopia).  Well, maybe I dream that such a place could and should exist; after all, I am a nurse.  However; I also understand reality.  One reality that we must all be aware of is a simple fact: a very small percentage of nurses, many of whom have little or no recent clinical nursing experience are guiding our profession.   They have supported a divisive environment created in 1965, and they have failed to deliver what is best for nurses, nursing, and the public at large.  We must all become more involved with our professional associations, we must join our professional associations, we must hold them accountable to our wishes.  Associations are nothing but micro-politics of democracy.  As long as we let the minority of nurses represent the whole, the majority will always feel and be disenfranchised.  Make the associations work for you and your profession.  Join in, encourage your colleagues to join.  Become involved and speak-up for a solidarity among all nurses, of all levels.  There will always be a need for nursing, let's make it one mighty and powerful voice. 

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This is the first in a series of articles that I will be publishing on this subject.  If you'd like to send me feedback, input, or your own op-ed, please feel free to so.  To e-mail me .

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